Ketepatan Skoring McIsaac untuk Mengidentifikasi Faringitis Group A Streptococcus pada Anak
Sari
Latar belakang. Pemberian antibiotik faringitis Group A Streptococcus (GAS) penting untuk mencegah komplikasi demam rematik dan penyakit jantung rematik. Namun, gambaran klinis saja tidak dapat diandalkan untuk memastikan atau menyingkirkan faringitis GAS. Skoring McIsaac merupakan sistem penilaian klinis untuk memprediksi faringitis GAS yang penggunaannya dapat meningkatkan ketepatan identifikasi kasus faringitis GAS serta kebutuhan akan antibiotik.
Tujuan. Menguji ketepatan skoring McIsaac dalam mendiagnosis faringitis GAS anak.
Metode. Uji diagnostik yang dilakukan dari bulan Januari-Agustus 2012 pada 96 anak usia 3-14 tahun dengan faringitis akut di RSUP Dr Mohammad Hoesin dan Puskesmas Pembina, Palembang. Skoring McIsaac dihitung berdasarkan empat gejala klinis yang hasilnya dibandingkan dengan rapid antigen detection test (RADT) atau biakan usap tenggorok apabila RADT negatif. Analisis data menggunakan piranti lunak SPSS versi 17.0 dan Stata SE 10.0.
Hasil. Ditemukan 13,54% faringitis GAS. Titik potong optimal skoring McIsaac ≥4 dengan sensitivitas 84,62% (IK 95% 54,55-98,08%), spesifisitas 68,67% (IK 95% 57,56-78.41%), nilai duga positif 29,73% (IK 95% 15,87-46,98%), dan nilai duga negatif 96,61% (IK 95% 88,29-99,59%). Untuk nilai 5 mempunyai sensitivitas 38,46% (IK 95% 13,86-68,42%), spesifisitas 98,8% (IK 95% 93,47-99,97%), nilai duga positif 83,33% (IK 95% 35,88-99,58%), dan nilai duga negatif 91,11% (IK 95% 83.23-96,08%).
Kesimpulan. Diagnosis faringitis GAS dapat disingkirkan apabila hasil skoring McIsaac <4, memerlukan pemeriksaan penunjang lebih lanjut (RADT atau biakan usap tenggorok) pada hasil skoring 4, dan sangat mungkin (98,8%) untuk hasil skoring 5.
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DOI: http://dx.doi.org/10.14238/sp15.5.2014.301-6
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